As the oncology clinical nurse specialist, I was called and asked to consult with an elderly woman with advanced lung cancer who was admitted from the emergency department. The staff requested my help in planning her care to get her pain under control and to address her altered cognition. She was confused, agitated, and refused to take any medications. The nurses informed me that her son was with her, a surgeon visiting from out of state.
When I initially entered the patient's room, I observed a thin, frail, somewhat jaundiced, bald woman, picking at her clothes and verbally objecting to a middle-aged man's (I assumed this was her son) attempts to orient her as to why she was in the hospital. I introduced myself saying I was a resource nurse that worked on the unit. Motioning with my hands, I asked the patient if it would be alright if I sat on her bed, toward her feet. She eyed me warily (as did her son), but then she nodded affirmatively. I sat.
With eye contact, a concerned facial expression, and posture leaning toward her, I attempted to convey warmth and compassion. I then asked, “Are things feeling all mixed up?” Hesitating a few moments, she then answered “Yes,” and elaborated, “I'm not sure what's going on here. I just want to stop this terrible ache in my back.” Following these words, I gently reached for her hand. Almost simultaneously, her son spoke. With a raised, somewhat exasperated voice, he reviewed the chronology of her symptoms, recent bone scan findings, rising calcium levels, and her refusal to take her pain medications at home. I waited a few minutes and then turned toward the patient's son and reflected, “It must be hard to see your mother so upset and uncomfortable.” Upon hearing this, I could see him attempt to minimize his emotional response to my words of support. Yet, I saw tears form in the corner of his eyes. I thought, here was a man trained to remove sources of pain and disability, yet he felt impotent to do such for his mother.
Attempting to foster the patient's feelings of trust, the nurses and I quickly came up with a plan for her care that involved having a limited number of staff interacting with her who verbalized consistent messages of emotional support and efforts to maximize her orientation. With a pharmacologic protocol of ongoing and intermittent drugs to manage her pain, we were able to significantly reduce her distress during her initial 24 hours of hospitalization.
During the patient's short stay, I asked the patient's son if he would like to talk with me outside his mother's room. He declined, saying he was alright and that as soon as his mother's pain was under control he would feel better. The next morning the patient was discharged home with hospice home care. Ultimately, the initial contact in the patient's room was the only one I had with the patient's son. A month later, I received an email from him telling me that his mother died 4 days following her discharge. He relayed his gratefulness for the patience and attentiveness the oncology unit nursing staff extended to his mother. He then shared his thoughts about our initial meeting in his mother's hospital room and said the following:
While we speak of healthcare being team oriented, it remains hierarchical with the physician's interventions repeatedly being highlighted front and center. Yet in reality, our contributions are marginal when compared to nurses who spend the most time with patients and families and have an expansive skill set unlike any other team member. I realized this firsthand in witnessing the care my mother received.
As a surgeon, I have been trained to reduce, remove, repair, and remedy the physical maladies my patients face. I have learned over decades to do this well with the aid of tools, machinery, and other technology within my grasp. Yet in experiencing my mother's cancer as a son, I came to realize that these skills are extremely limited when considering the full scope of coping with a life-threatening diagnosis. Before my mother became sick, I gave little thought to the nonphysical consequences of disease. Yet I have been forced to acknowledge the overwhelming losses patients and families must endure, the ongoing confusion prompted by information lapses, and the abject fear that accompanies your every waking minute.
I wanted you to know that in seeing how you interacted with my mother I came to appreciate the power of presence. This skill I had historically diminished because of its “soft” nature. I came to realize that while I had always thought of myself as an exceptional surgeon, I was merely being a technician. I was not proficient in the competencies that really count, namely, communication and compassion, which you exuded.
Because of you and your nurse colleagues, I now have a newfound appreciation that there is so much more to illness and recovery than how my hands perform. I need to become equally adept in listening, observing, and reflecting, skills as important as cutting, cauterizing, and suturing. While it is unfortunate that I came to this awareness late in my career due to my personal devastation of the loss of my mother, I am thankful you gave me the opportunity to grow and become a better surgeon because of it.
In today's healthcare environment characterized by numbers, technology, dollars, and data, we must make a concerted and parallel effort to elevate the importance and quality of humanistic interactions. It is this interpersonal competency that uniquely positions nurses as central professional caregivers. We have the capacity and obligation to master, teach, and role model the holistic domain to our colleagues as this is the essence and power of nursing excellence.